阿德福韦酯治疗前后乙型肝炎病毒C基因型耐药性分析及病毒变异探讨

Drug resistance of C genotype of hepatitis B virus before and after treatment with adefovir and virus mutation

目的研究阿德福韦酯治疗乙型肝炎病毒C基因型耐药性变化,并分析其相应的基因变异,为临床合理用药提供依据。方法选择医院32例乙型慢性肝炎患者作为研究对象,采用聚合酶链式反应测定患者肝炎病毒C基因亚型及病毒基因的基本核心启动子BCP及前C区变异,并分别于21、48、120周对患者HBV-DNA阴转率进行检测。结果患者基因中C1分布高于C2,且C1亚型具有较高BCP变异,C2亚型具有较高PC变异;治疗后C1、C2基因型的变异阳转率显著降低,与治疗前比较,差异有统计学意义(P<0.05)。结论慢性乙型肝炎病毒C基因型具有较高的变异率,是造成耐药性产生的重要原因,阿德福韦酯对于乙型肝炎病毒C型耐药性患者具有很好的疗效,可以明显降低病毒的变异,提高治疗效果。

OBJECTIVE To study the drug resistance of C genotypes of hepatitis B virus （HBV）before and after the treatment with adefovir and analyze the mutations of relevant genes so as to guide the reasonable use of antibiotics. METHODS A total of 36 cases of chronic hepatitis B patients were selected as the research objects, then the polyr merase chain reaction was carried out to determine the C genotype of HBV and C virus gene and the basic core promoters （BCP） as well as the former area C mutation, the HBV-DNA negative rate was respectively detected at 21st, 48th, and 120th week. RESULTS Of the genotypes detected in the patients, C1 was more prevalent than C2, with higher mutation of BCP. The positive rate of mutation of C1 or C2 was significantly decreased after the treatment as compared with that before the treatment, the difference was significant （P〈0.05）. CONCLUSION The mutation rate of the C genotypes of chronic HBV is high, which is the main cause of drug resistance; adefovir can achieve very good curative effect on the patients with C genotype of drug resistant HBV, significantly reduce the virus mutation, and improve the therapeutic effect.